Severe Burn Patients Research Articles

Nomogram based on burn characteristics and the national early warning score to predict survival in severely burned patients

BackgroundExtensive burns are associated with a high mortality rate. Early prediction and action can reduce mortality. The National Early Warning Score (NEWS) is considered the best early warning score for predicting mortality. However, there has been no assessment conducted on the clinical prognostic significance of NEWS in individuals suffering from severe burns. The objective of this research was to establish a nomogram based on burn characteristics and the NEWS to predict survival in severely burned patients. MethodsA retrospective analysis was performed on 335 patients diagnosed with extensive burns from 2005 to 2021 in the Department of Burn Surgery of XX Hospital. Univariate and multivariate analyses were used to determine independent prognostic factors. A nomogram was developed using these prognostic factors and its internal validity was assessed through bootstrap resampling. ResultsThe results of multivariate analysis showed that the independent factors affecting the prognosis of severe burn patients were age, full-thickness burn, creatinine, absorptive injury, tracheotomy, and the NEWS, all of which were identified to create the nomogram. The Akaike Information Criterion and Bayesian Information Criterion values of the nomogram demonstrated superior goodness-of-fit in predicting severe burns compared to NEWS, with lower scores (195.21 vs. 201.24; 221.91 vs. 224.12, respectively). The bootstrap-adjusted concordance index (C-index) of the nomogram yielded a higher value of 0.923 (95% CI 0.892–0.953), compared to NEWS which had a C-index of 0.699 (95% CI 0.628–0.770). The calibration curves demonstrated excellent agreement between predicted probabilities and observed outcomes in the nomogram analysis. Furthermore, decision curve analysis indicated promising clinical utility for the proposed nomogram model. By applying an appropriate cutoff value derived from receiver operating characteristics curve analysis, it was observed that the high-risk group identified by the nomogram exhibited a significantly higher mortality rate than the low-risk group. ConclusionThis study introduces an innovative nomogram that predicts the survival rate of individuals with severe burn injuries by combining clinical attributes and laboratory examinations, demonstrating superior efficacy compared to conventional NEWS systems.

Optimising Processes in a Severe Burn Intensive Care Unit through the Implementation of a Digital Management System

The treatment of severely burned patients is demanding and necessitates specialised centres capable of providing adequate therapy over several months. The establishment of digital management systems in intensive care units signifies a substantial advancement in modern healthcare. Introducing such a system in a specialised intensive care unit for severe burn patients presents opportunities for optimisation but also potential obstacles. This study aims to provide insights into the perception of change from the perspective of staff and discuss the implementation of digital systems in the field of intensive care medicine. After a selective sample was established, the impacts of the digital management system were examined across various categories. The data collected through a questionnaire and brief interviews were evaluated in terms of average values within each category, with interpretations taking into account characteristics such as professional group and work experience. Overall, the digital management system is considered suitable for use in the intensive care unit for severe burn patients by both medical and nursing staff. The continuous monitoring of vital parameters and the reduction of errors in medication administration are highlighted as positive aspects. However, negative points include the inferior documentation of burn wounds and specialised documentation for burn patients. In due consideration of various factors such as experience, team size, and patient clientele, which impact the usability of the program, some aspects in need of improvement were identified. In summary, however, it can be said that there was a positive and favourable consensus regarding the introduction of such a system in the intensive care unit. Additionally, it can be concluded that the system is described as significantly more effective for a general surgical intensive care unit than for a specialised intensive care unit, e. g. an intensive care unit for severe burn patients.

Effects of intravenous Tranexamic Acid on bleeding during burn surgery: a double-blinded randomized clinical trial

Blood loss during burn surgeries significantly contributes to morbidity and mortality. Tranexamic Acid (TXA), an antifibrinolytic agent, is hypothesized to reduce intraoperative bleeding. This double-blinded, randomized clinical trial aimed to assess the efficacy of systemic TXA in severe burn patients (total body surface area [TBSA] >20%) undergoing surgery. The study evaluated the impact of TXA on surgical bleeding, operating room (OR) time, intravenous (IV) fluid requirements, length of hospital stay (LOS), and overall patient outcomes. A total of 94 patients, with equal distribution in age, sex, and TBSA, were randomly assigned into two groups (47 each). We administered TXA as a 10mg/kg loading dose followed by a 1mg/kg/h infusion during surgery. Results demonstrated significant reductions in blood loss (P-value: 0.043), total IV fluid volume (P-value: 0.021), OR time (P-value: 0.002), LOS (P-value: 0.0001), and transfusion necessity (P-value: 0.024) in the TXA group. Notably, women and patients without inhalation injuries exhibited better responses to TXA treatment, and graft survival was lower in the TXA group. The study concludes that IV TXA administration during burn surgeries can effectively reduce bleeding, minimize IV fluid and blood transfusion needs, and shorten surgery duration, enhancing overall surgical outcomes.

Update burn surgery: overview of current multidisciplinary treatment concepts

Abstract The treatment of severe burn injuries is an essential part of plastic-reconstructive surgery. Severe burned patients are treated in burn centers, which have highly specialized technical and personnel equipment. In addition to clear recommendations for prehospital management, intensive care therapy is usually required for extensive burn wounds. Shock therapy in burns primarily involves balanced fluid resuscitation according to hemodynamic monitoring, vasopressor support, pain management, temperature regulation, oxygen therapy, and comprehensive supportive care to stabilize the patient’s condition. Surgical treatment is still based on wound debridement and the gold standard of autologous split-thickness skin grafting. Besides skin transplantation, surgical management of burns may also involve the application of various topical therapies to promote wound healing, reduce pain, and prevent infection. These therapies may include antimicrobial dressings, skin substitutes, growth factors, or specialized wound care products. Once the acute treatment has been completed, multidisciplinary rehabilitation treatment takes place, which begins in the acute hospital and continues in the outpatient and inpatient rehabilitation areas. Surgical treatment of the secondary complications of burns and scars is also an important component of burn care. Comprehensive knowledge of the various components and players involved in the care of severely burned patients is, therefore, required in order to achieve the best possible outcome for the patient.

Galectin-3 and Soluble CD146 Identify Cardiorenal Injuries in Severe Burn Patients: A Biomarker-Based Approach.

Acute kidney injury (AKI) and myocardial injury (MI) are severe conditions in patients with severe burn injury, and combination of both is even worst and is called the cardiorenal syndrome (CRS). Identifying a distinct cardiorenal phenotype could significantly enhance the management of these patients. Galectin-3 (Gal3) and soluble CD146 (sCD146) are biomarkers for renal and cardiac injuries. This study aims to assess the occurrence and reliability of these biomarkers in recognizing CRS in individuals who have been severely burn. This study is a single-center prospective proof-of-concept study involving patients with severe burn injuries. Plasma samples for Gal3 and sCD146 measurements were collected daily during the initial 7 days following admission. CRS was defined after 24 h of admission by the association of AKI stage 1 or more (KDIGO definition) and MI defined on high sensitive troponin (hsTnT) (variation >20% baseline value or absolute value >40 ng/mL). Forty patients met the inclusion criteria and were included in this study. Thirty-eight patients had CRS. The pooled values of Gal3 or combination of Gal3 and sCD146 values following 7 days after admission were associated with CRS with an odds ratio (OR) of 1.145 (95% CI: 1.081-1.211), p < 0.001, and 1.147 (95% CI: 1.085-1.212), p < 0.001, respectively. Gal3 values at admission (D0) had a predictive performance for CRS with an AUC of 0.78 (95% CI: 0.63-0.93), and this performance improved when using the combination of Gal3 and sCD146 values at admission (D0), with an AUC of 0.81 (95% CI: 0.66-0.96). Gal3 levels during the first 7 days were associated with patients experiencing AKI and no MI, with an OR of 1.129 (95% CI: 1.065-1.195), p < 0.001, and MI without AKI with an OR of 1.095 (95% CI: 1.037-1.167), p < 0.001. sCD146 alone was not associated with AKI without MI or MI without AKI and was poorly associated with CRS. In severely burned patients, CRS is a frequent and severe condition. Gal3 values during the first 7 days following admission were associated with CRS. The use of sCD146 with Gal3 improved prediction performance for CRS identification. The use of such biomarkers to identify CRS is important and needs to be confirmed in other studies.

Acute phase optimization in burn care: Online tools and comprehensive predictive models for adult and pediatric patients

BackgroundSevere burn injuries significantly challenge acute medical care, particularly in resource-limited environments. Current predictive scoring systems, often impractical and adult-focused, neglect crucial aspects like mechanical ventilation and length of hospital stay (LOS). MethodsThis study analyzed 2,618 severe burn patients, developing new predictive models for survival, mechanical ventilation, and LOS, based on promptly accessible factors applicable in any setting. ResultsWe observed significant seasonality and clear age- and gender-specific patterns, highlighting the necessity for targeted interventions. We developed and publicly released new predictive models for mortality, mechanical ventilation, and LOS for both adult and pediatric populations. DiscussionTargeting deficiencies in existing scoring systems, this study potentially advances acute burn management, with a particular focus on resource-limited settings. It provides crucial insights into the epidemiology, etiology, and prognostic factors of severe burn injuries, encapsulated in 10 actionable points. We also present an innovative freely accessible online assessment tool: https://burn-scores.com. ConclusionBy bridging gaps in current scoring methodologies and improving acute phase management, our research offers insights to improve clinical outcomes for severe burn patients globally. The integration of tailored predictive models and technology-driven solutions, especially relevant in resource-constrained settings, represents a major stride in enhancing the quality of burn care.

Effect of three different exercise trainings on functional capacity in early stage severe burn patients: A randomized controlled trial.

This study investigated the effects of three different exercise protocols on functional capacity in early-stage burn patients. A total of 25 patients hospitalized in the Burn Center (wards and intensive care unit) were included in the study. The individuals were divided into three groups by covariate adaptive randomization according to burn percentage and type: 1 - standard treatment, 2 - standard treatment + aerobic exercise training, 3 - standard treatment + combined exercise (aerobic and resistance) determined by metabolic status. Individuals were evaluated weekly for six weeks from the first day of hospitalization using the 6-minute walk test, physiological cost index, and Medical Research Council muscle-strength measurements to assess functional capacity. A portable metabolism tracker device measured the metabolic status of all patients. Aerobic exercises and combined exercise (aerobic and resistance), when added to standard treatment and determined by metabolic status, were more effective in enhancing functional capacity than standard treatment alone (p<0.05). Patients performing the combined exercise (aerobic and resistance) showed faster improvement in functional capacity determined according to metabolic status than those in the other two groups (p<0.05). Aerobic exercises, when added to standard treatment and combined with aerobic and resistance exercises based on metabolic status, are more effective at improving functional capacity than standard treatment alone. Further controlled studies are required to explore the potential long-term benefits of this approach.

Delayed admission to hospital with proper prehospital treatments prevents severely burned patients from sepsis in China: A retrospective study

BackgroundSepsis is one of the major causes of morbidity and mortality in burn patients. However, the optimal timing of admission which can minimize the probability of sepsis is still unclear. This study aims to determine the optimal time period of admission for severely burned patients and find out the possible reasons for it. Method185 victims to the Kunshan factory aluminum dust explosion accident, which happened on August 2nd, 2014, were studied. The optimal cutpoint for continuous variables in survival models was determined by means of the maximally selected rank statistic. Univariate and multivariate analyses were further conducted to verify that admission time was not a risk factor for sepsis. Subgroup analyses were performed to find out possible contributing factors for the result. ResultThe cutoff point for admission time was determined as seven hours, which was supported by the survival curve (p < 0.001). Multivariate analysis showed that, in our study population, delayed admission time was not a risk factor for sepsis (HR = 0.610, 95 %CI = 0.415 - 0.896, p = 0.012). Subgroup analyses showed that “Tracheotomy before admission” (p = 0.002), “Whole blood transfusion” (p < 0.001), “Hemodynamic instability before admission” (p = 0.02), “Has a burn department in the hospital” (p = 0.009), “Has a burn ICU in the hospital” (p < 0.001), “Acute heart failure (AHF)” (p = 0.05), “acute respiratory distress syndrome (ARDS)” (p = 0.05) and “GI bleeding” (p = 0.04) were all statistically significant. ConclusionIn our study population, we found that delayed admission time was not a risk factor associated with a reduced incidence of sepsis among severely burned patients. This might be attributed to variations in prehospital treatments (whole blood transfusion and tracheotomy), whether the hospital had a burn department/ICU, and certain complications (AHF, ARDS and GI bleeding). It can be inferred that early prehospital care plays a crucial role in reducing sepsis risk among severe burn patients.

Non-invasive assessment of intracranial pressure in severe burned patients: from animal models to bedside

Non-invasive assessment of intracranial pressure in severe burned patients: from animal models to bedside

Association between Sick Euthyroid Syndrome and Poor Prognosis in Severe Burn Patient

Abstract Background Euthyroid sick syndrome (also known as non-thyroidal illness syndrome) can be described as abnormal findings on thyroid function tests that occur in the setting of a non-thyroidal illness (NTI), without preexisting hypothalamic-pituitary and thyroid gland dysfunction. After recovery from an NTI, these thyroid function test result abnormalities should be completely reversible, study of euthyroid sick syndrome in burn patients. Aim of the Work The aim of study is to examine the ability of Euthyroid sick syndrome in predicting prognosis in severe burn patients. Patients and Methods A case control study was conducted in burn ICU in Ain Shams University Hospitals from march 2022 to September 2022,88 patients were admitted to study with 44 burn case with ESS and 44 burn case without ESS according to inclusion and exclusion criteria. Results The results showed that the group with ESS are more associated with higher rate of morality, hospital stay and more poor prognosis with worse APACHE score levels compared to the burn group with ESS. The study showed that using APACHE score with T3 levels measurements are more accurate in detecting morality in burn ICU patient. Conclusion The study demonstrated that ESS are more associated with higher rate of morality, hospital stay and more poor prognosis with worse APACHE score levels.

Risk Factors and Outcome Associated With Fungal Infections in Patients With Severe Burn Injury: 10-year Retrospective IFI-BURN Study.

In burn patients, skin barrier disruption and immune dysfunctions increase susceptibility to invasive fungal diseases (IFDs) like invasive candidiasis (IC) and invasive mold infections (IMI). We provide an in-depth analysis of IFD-related factors and outcomes in a 10-year cohort of severe burn patients. This retrospective cohort study includes adult patients admitted to the burn intensive care unit (BICU) between April 2014 and May 2023 with total burn surface area (TBSA) ≥15%. Patients were classified as proven IFD according to EORTC/MSGERC criteria applicable for IC. Putative IMIs were defined with: ≥2 positive cultures from a skin biopsy/bronchoalveolar lavage or ≥2 positive blood specific-quantitative polymerase chain reactions (qPCRs) or a combination of both. Among 1381 patients admitted, 276 consecutive patients with TBSA ≥15% were included. Eighty-seven (31.5%; IC n = 30; IMI n = 43; both n = 14) patients fulfilled the criteria for probable/putative IFD. At Day 30 after the burn injury, the estimated cumulative incidence proven/putative (pr/pu) IFD was 26.4% (95% confidence interval [CI], 21.4%-31.8%). Factors independently associated with IFDs were TBSA, severity scores and indoor burn injury (ie, from confined space fire). Overall mortality was 15.3% and 36.8% in the no IFD, pr/pu IFD groups respectively (P < .0001). IFD was independently associated with a risk of death (hazard ratio [HR]: 1.94 for pr/pu IFD; 95% CI, 1.12-3.36; P = .019). This study describes twenty-first-century characteristics of IFDs in severe burn patients confirming known risk factors with thresholds and identifying the indoor injury as an independent factor associated to IFDs. This suggests a link to contamination caused by fire damage, which is highly susceptible to aerosolizing spores.

Assessment of the quality of life of moderate and severe burn patients in Saudi Arabia using the Burn Specific Health Scale-Brief

Improvements in the mortality rate for burn injuries has led to an increase in the number of major burn survivors. Burn injuries pose significant physical and psychological consequences that impact the quality of life of burn survivors. The current study assessed the quality of life of major burn survivors in Saudi Arabia using the Burn Specific Health Scale-Brief (Arabic version). A total of 48 major burn survivors completed a validated online survey. Additional data, including demographics, burn injury characteristics, and treatment strategies, were collected from electronic health records. The mean extent of the patients’ burn injuries was 32 % of total body surface area. The average number of surgical interventions was four (ranging between two to 15 procedures). Over 40 % of the patients experience significant difficulties in performing their jobs. About 94 % are bothered by the appearance of their burn scars. Exposure to sun and hot weather remains a significant burden for the majority. The mean scale score was 99 out of 148. The number of surgical interventions was found to be related to a lower quality of life score (p-value = 0.02). Gender, age, and total body surface area had no predictive value for lower quality of life after burn injury. Even several years after sustaining burn injuries, burn patients continue to exhibit long-term complications and limitations in their functional status and daily living. Furthermore, the number of surgical interventions burn survivors have undergone is a negative predictor for their quality of life.

Optimizing Nutritional Needs of Burn Patients: An Evaluation of Nutritional Assessment Tools, Feeding Strategies, and Their Impact on Patient Outcomes.

Optimal nutritional support is essential to the recovery and improved outcomes of burn patients. This review aims to explore existing literature to evaluate nutrition assessment tools, feeding formulations' caloric predictive ability, timing of initiation of feeding, optimal nutritional composition, and caloric intake in burn patients. Three databases were searched to glean studies investigating nutrition in acute severe adult burn patient populations in four areas: outcomes based on feeding type and timing, the caloric predictability of nutritional assessment tools, outcomes associated with the composition of feeding formulas, and considerations related to caloric intake. Outcomes of interest included the effects of nutritional assessments using feeding type, nutritional administration timing, formula composition, and caloric intake on mortality rate, length of stay, and infection. A total of 19 studies were included. Nutritional assessment tools were determined to over- or underestimate resting energy expenditure (REE). Milner was the most accurate alternative to indirect calorimetry. Early enteral nutrition in burn patients within 24hours of admission was preferred. 5 studies evaluated micronutrients and yielded variable results. Low-fat high-carbohydrate diets were the ideal macronutrient composition. Burn patients were shown to receive lower caloric intake than recommended. Findings showed that while nutritional assessment tools tend to inaccurately estimate REE in burn patients, the ideal alternative to indirect calorimetry is the Milner equation. Several new equations may be worthy alternatives but require further validation. Enteral feeding should be initiated within the first 24hours of burn injury whenever possible and should contain a high-carbohydrate/low-fat composition.

A Meta-Analysis of the Mortality and the Prevalence of Burn Complications in Western Populations.

Management of burn injuries is complex, with highly variable outcomes occurring among different populations. This meta-analysis aims to assess the outcomes of burn therapy in North American and European adults, specifically mortality and complications, to guide further therapeutic advances. A systematic review of PubMed, Web of Science, and Cochrane was performed. Random-effect meta-analysis of proportions was conducted to assess the overall prevalence of the defined outcomes. In total, 54 studies were included, pooling 60 269 adult patients. A total of 53 896 patients were in North America (NA, 89.4%), and 6373 were in Europe (10.6%). Both populations experienced similar outcomes. The overall pooled prevalence of mortality was 13% (95% CI, 8%-19%) for moderate burns, 20% (95% CI, 12%-29%) for severe burns in the NA region, and 22% (95% CI, 16%-28%) for severe burns in Europe. Infectious complications were the most common across both regions. European studies showed an infection rate for patients with moderate and severe burns at 8% and 76%, respectively, while NA studies had rates of 35% and 54%. Acute kidney injury (39% vs 37%) and shock (29% vs 35%) were the next most common complications in European and NA studies, respectively. The length of stay was 27.52 days for patients with severe burns in Europe and 31.02 days for patients with severe burns in NA. Burn outcomes are similar between Western populations. While outcomes are reasonably good overall, infectious complications remain high. These findings encourage the development of further therapeutic strategies disclosing respective costs to enable cost/efficiency evaluations in burn management.

Effect of high sodium ion level on the interaction of AmB with a cholesterol-rich phospholipid monolayer.

Invasive fungal infections are a primary reason for high mortality in immunocompromised people, especially in critically ill patients, such as intensive care unit (ICU) patients, advanced cancer patients, or severe burn patients. Hypernatremia also can increase mortality in severely ill patients. Amphotericin B (AmB) is the gold standard for treating infections, but in severely ill patients, AmB can cause hematotoxicity when administered intravenously due to its interaction with cholesterol on red blood cell membranes. This results in limited doses of AmB and affects the treatment of infections. The proportion of cholesterol molecules in membrane lipids in red blood cells is as high as 50mol%, and the sodium ions can influence the interaction between AmB and lipids on the membrane. Therefore, in the complex clinical situation of a severely ill patient with a fungal infection and hypernatremia, the interaction between amphotericin B and the red blood cell membranes is worth studying in depth. In this work, the interaction between AmB and the dipalmitoyl phosphatidylcholine (DPPC)/cholesterol mixed monolayer in the presence of high sodium ion levels was studied when the proportion of cholesterol was 50%. The results show that the effect of AmB on reducing the monolayer's area at a high level of sodium ions is slightly stronger at 30mN/m. The effect of AmB on reducing the elastic modulus of the DPPC/Chol monolayer is significantly weakened by a high sodium ion level, compared with the level of sodium ions at normal physiological concentration. The higher the sodium ion concentration, the weaker the intermolecular force of the DPPC/Chol/AmB mixed monolayers. The scanning electron microscope (SEM) and atomic force microscopy (AFM) observations suggest that at a high sodium ion level, the presence of AmB significantly reduces the surface roughness of the DPPC/Chol monolayer. AmB may bind to cholesterol molecules, and it isolates cholesterol from the monolayer, resulting in a reduced height of the cholesterol-rich monolayer and an increasingly dispersed monolayer region. The results are beneficial to understanding the mechanism of impact of a high sodium ion level on the relationship between AmB and red blood cell membranes rich in cholesterol and are valuable for understanding the hemolytic toxicity of AmB to red blood cells at a high sodium ion level.

1,25-Dihydroxyvitamin D3 reduces early mortality post severe burn injury via alleviating endotoxemia, oxidative stress and inflammation

Severe burn patients frequently suffer from 1,25-Dihydroxyvitamin D3 (1,25-[OH]2-D3) deficiency. In this study, we investigated the effect of 1,25-[OH]2-D3 on early mortality post severe burn and potential underlying mechanisms. Our results indicate that 1,25-[OH]2-D3 significantly reduced early mortality in mice post severe burn injury. A decrease in serum lipopolysaccharide levels and an increase in serum superoxide dismutase activity were found after administration of 1,25-[OH]2-D3. Furthermore, 1,25-[OH]2-D3 demonstrated protective effects on both intestinal and lung histology and ameliorated lung inflammation. Its anti-inflammatory effect was further confirmed in airway epithelial cells. In conclusion, our study provides evidence that 1,25-[OH]2-D3 has a significant impact on the reduction of early mortality post severe burn injury, possibly through its ability to alleviate endotoxemia, oxidative stress, and inflammation. Our findings highlight the potential of 1,25-[OH]2-D3 to protect the intestinal mucosal barrier in the early stage following major burn injury and opens up new avenues for clinical application of 1,25-[OH]2-D3 in burn patients.

86 Hypothyroidism Associated with Increased Risk of Developing Contractures and Skin Disorders in Severe Burn Patients

86 Hypothyroidism Associated with Increased Risk of Developing Contractures and Skin Disorders in Severe Burn Patients

Revalidating the prognostic relevance of the Abbreviated Burn Severity Index (ABSI): A twenty-year experience examining the performance of the ABSI score in consideration of progression and advantages of burn treatments from a single center in Vienna

BackgroundThe Abbreviated Burn Severity Index (ABSI) is a five-variable scale to help evaluate burn severity upon initial assessment. As other studies have been conducted with comparatively small patient populations, the purpose of this study is to revalidate the prognostic relevance of the ABSI in our selected population (N = 1193) 4 decades after its introduction, considering the progress in the treatment of severe burn injuries over the past decades. In addition, we evaluate whether comorbidities influence the survival probability of severely burned patients. MethodsThis retrospective study presents data from the Center for Severely Burned Patients of the General Hospital in Vienna. We included 1193 patients for over 20 years. Regression models were used to describe the prognostic accuracy of the ABSI. ResultsThe ABSI can still be used as a prognostic factor for the probability of survival of severely burned patients. The odds of passing increases by a factor of 2.059 for each unit increase in the ABSI with an area under the curve value of 0.909. Over time, the likelihood of survival increased. The existence of chronic kidney disease negatively impacts the survival probability of severely burned patients. ConclusionThe ABSI can still be used to provide accurate information about the chances of survival of severely burned patients; however, further exploration of the impact of chronic kidney disease on the survival probability and adding variables to the ABSI scale should be considered. The probability of survival has increased over the last 20 years.

Hematological Trends in Severe Burn Patients: A Comprehensive Study for Prognosis and Clinical Insights.

Severe burn injuries pose diagnostic challenges, contributing to increased fatality rates with delayed diagnoses. This study aims to identify early risk factors and understand their impact on clinical outcomes by examining hematological dynamics in severe burn cases. The focus includes age-related patterns, total body surface area (TBSA) affected by burns, hospital stay duration, and changes in hematological markers during burn injuries. An analytical cross-sectional study at the burn care center involved 135 participants hospitalized between January 2018 and December 2021. Demographic data and hematological markers were recorded, and statistical analysis was performed using IBM SPSS 25.0. Nonsurvivors exhibited a greater mean TBSA, shorter hospital stay, and an enhanced early immune response indicated by white blood cell count on the first day. Hematological markers, including hemoglobin, red cell count (RCC), and platelet count, showed dynamic patterns over the study period. Marginal variations in platelet counts and intriguing patterns in RCC suggested potential consequences like disseminated intravascular coagulation. The study provides crucial insights into hematological responses to severe burn injuries. Early identification of risk factors, particularly age-related patterns and immune responses, informs clinicians about predicting outcomes and guiding therapeutic interventions. Despite limitations, this work underscores the need for further multicenter research to comprehensively understand the complex relationships between burn injuries, hematological responses, and clinical outcomes.

Delineating Gastrointestinal Dysfunction Variants in Severe Burn Injury Cases: A Retrospective Case Series with Literature Review

Background: Severe burns can significantly impact various organ systems, including the gastrointestinal (GI) system. GI complications are frequently observed in patients with over 20% total body surface area (TBSA) burn. Objectives: This case series delves into the intricate phenomenology of post-burn GI dysfunction, challenging conventional cause-and-effect paradigms. Our aim is to discern, comprehend, and explore variables influencing positive and negative outcomes, laying the foundation for further research given the current heterogeneity in the literature. Methods: Severe burn patients with GI dysfunction identified between April 1, 2022, and July 31, 2022, from the institutional database are included in this retrospective case-series, and comparisons were made across baseline and treatment conditions across participants. Data were collected on demographics, burn characteristics, complications, and treatment outcomes. Results: We analysed 12 patients with severe burns and GI dysfunction and categorized them into two patterns: Pattern A, characterised by early onset symptoms, gastric and small bowel dilatation, and a relatively benign course with high recovery rates was observed in 6 patients; and Pattern B, characterised by late-onset symptoms, colonic dilatation, shock, and a high mortality rate due to megacolon was seen in 6 patients. Conclusion: The post-burn GI dysfunction observed in our study is a complex interplay of multiple factors. Adequate fluid resuscitation, timely excision of necrotic tissue, staged food ingestion, specific nutrient administration, and appropriate use of antibiotics and judicious use of selective digestive decontamination (SDD) are essential strategies to prevent and treat this syndrome.